New test predicts damage from diabetes

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An Australian scientist has begun human trials of a test that
has the potential to be as significant to health care as measuring
cholesterol levels.

Merlin Thomas, of Melbourne's Baker Heart Research Institute, is
in the process of refining a blood test aimed at predicting the
likelihood of organ damage in those with elevated blood-sugar
levels, particularly patients with diabetes.

The test is based on determining the level of advanced glycation
end-products (AGEs) in the body, which form when sugar damages
proteins.

Associate Professor Thomas says the process is much the same as
what happens when brown sugar and butter are mixed together to make
caramel but when it occurs in the body, the result is nowhere near
as sweet.

AGEs are known to be involved in hardening of the arteries,
Alzheimer's disease, ageing of the skin and kidney disease.

Basically, they contribute to the ageing process, slowly
"caramelising" us through time, Prof Thomas says. They cause tissue
to become stiffer - the same process as what makes mutton tougher
than lamb.

Although AGEs are present in everybody, they accumulate much
more quickly when sugar concentration is high, one of the reasons
why strong sugar control is so important for those with
diabetes.

The process means people with diabetes are at increased risk of
heart attacks, strokes, kidney failure and blindness at an earlier
age.

Kidney Health Australia has recently given the Baker Institute
$1 million to further its research into AGEs.

Already Baker scientists have successfully trialled a "crude"
test for AGEs on more than 1,000 patients with diabetes, finding it
to be an accurate predictor of the likelihood of complications.

But Prof Thomas said much more work needed to be done before
general practitioners could use it.

"We need to refine it, make it even more precise," he said.

"I would think we're looking at five to 10 years before it will
become available in one shape or another."

Prof Thomas said if doctors could reduce AGEs levels in the
body, along with current strategies to control sugar, cholesterol
and blood pressure, then it may be possible to avoid the
complications of diabetes, including damage to the kidneys, eyes
and heart vessels.

"What we're wanting to do with AGEs is the same thing that's
been done with cholesterol," Prof Thomas said in an interview.

"We want to establish what increases AGEs in the body and what
is the best way to reduce them."

Some medications to treat AGEs already exist.

But others are being developed, including international human
trials of a novel drug, known as alagebrium, which aims to break
down pre-existing AGEs and make hardened tissue supple again.

"It'll be a couple of years before we have the full results but
our preliminary studies have been extremely positive," Prof Thomas
said.

"The key to reducing the impact of diabetes is to break the link
between high sugar levels and the damage they cause. AGEs are one
of those links.

"For the millions of Australians with diabetes who struggle to
control their sugars every day, an understanding of this will
provide an important advance to their care."